1770798191 NPI number — TEJINDER S SANDHU M D INC

Table of content: (NPI 1770798191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770798191 NPI number — TEJINDER S SANDHU M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEJINDER S SANDHU M D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEJINDER S SANDHU M D INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770798191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7826
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93747-7826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-875-7149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 JENSEN AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SANGER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93657-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-875-7149
Provider Business Practice Location Address Fax Number:
559-875-9661
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANDHU
Authorized Official First Name:
TEJINDER
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
559-875-7149

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A33330 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: A64661 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: A96343 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: A67160 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0083130 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0083131 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB88758F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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